Haiti already faced a daunting path to recovery in the wake of the catastrophic 2010 earthquake that destroyed much of its capital city, with devastating damage to the nation’s health infrastructure, when UN peacekeeping forces came from Kathmandu came to provide support. Unknown to them, some had been infected with cholera in their previous posting, and although they did not have symptoms, the massive outbreak that followed made an estimated 687,000 people in Haiti sick, killed about 8,500, and established the disease as one that remains endemic there still.
The outbreak is one of a series of devastating illnesses of pandemic potential imported by military personnel responding to already precarious conditions, documented in a recent Journal of Infectious Diseases report that, the authors note, have demonstrated needs for heightened disease prevention and public health measures among a vulnerable and mobile population.
Noting increasing risks of disease spread as the role of military responders expands to humanitarian crises wordwide that include political conflict, terrorism, natural disasters and epidemics even as urbanization and global trade and travel open new avenues for global health threats, the authors reviewed reports since the end of the Korean War opened the modern military era.
In 67 reports involving thousands of service members, they found 21 reports documenting bacterial infections carried from deployment locations, 23 reports of parasitical infections, and 23 of viruses. In addition to Haiti’s imported cholera outbreak they include the importation of pandemic influenza into Kuwait and Iraq, and the spread of sexually transmitted diseases where military responders are stationed including the emergence of penicillin-resistant gonorrhea among service members stationed in Asia during the Vietnam war, and the spread of HIV worldwide. In addition, they note the transportation of pathogens that even without a resulting outbreak demonstrate potential future challenges, including in the spread of treatment-resistant infections.
Noting that their review, which drew data from peer-reviewed journals, likely under-represents the scope of importation and transmission of infections, the authors call for further research to inform and support efforts to strengthen military public health and prevention measures.